Spotlight on the Continual Applicability of Routine Plasma Monitoring Antiepileptic Drugs in the Treatment of Epilepsy

Desoky, Ehab El; Kandil, Mahmoud R.; Afifi, Abdel-Halim M.; Mostafa, Ossama A.

doi:10.1006/phrs.1998.0424

Cited by 10 publications

(4 citation statements)

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“…10 Plasma concentrations of drugs are monitored at regular intervals to evaluate therapy efficiency in patients with epilepsy, especially in patients who receive two or more antiepileptic drugs simultaneously. 1,11 According to our study results, it was found that the average plasma carbamazepine (3.39 + 0.27 mg/ml; Figure 1) and valproic acid (44.44 + 2.51 mg/ml; Figure 3) concentrations decreased below the therapeutic index, and the decrease was significant when administered in combination with phenytoin. The average plasma carbamazepine concentration decreased when administered in combination with phenytoin; this observation was similar to that of the other studies.…”

Section: Discussionmentioning

confidence: 73%

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The effect of combination therapy on the plasma concentrations of traditional antiepileptics

2012

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The present study aimed at determining the differences in plasma concentrations of traditional antiepileptics such as phenytoin, carbamazepine, and valproic acid in patients receiving monotherapy and combination therapy. In addition, the effect of gender and age on plasma drug concentration was evaluated in these patients. For this purpose, plasma trough concentrations obtained during routine therapeutic monitoring of these drugs were assessed retrospectively. The average plasma concentrations reached the apparent therapeutic ranges, except for the average plasma concentration of phenytoin, which was below the therapeutic range in patients who received only phenytoin or in combination with the other agents. Phenytoin when combined with carbamazepine or valproic acid significantly decreased the average plasma concentrations of these drugs to subtherapeutic concentrations. The results showed that plasma carbamazepine concentrations were higher in men than in women, whereas plasma concentrations of valproic acid and phenytoin were higher in women than in men. The difference in this regard between men and women was found to be statistically significant for phenytoin. The difference between the average plasma concentrations of carbamazepine, phenytoin, and valproic acid among age groups was not significant. In conclusion, our study measured the average plasma antiepileptic drug concentrations in patients with epilepsy who were receiving monotherapy and combination therapy and were routinely monitored, and has thus shown the importance of drug monitoring in the evaluation of the effectiveness of these drugs.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

The effect of combination therapy on the plasma concentrations of traditional antiepileptics

2012

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“…[1][2][3] Whiting et al 4 proposed that a population pharmacokinetics (PPK) model could be imported to a Bayesian module of Nonlinear Mixed Effects Model (NONMEM) software, which may lead to increased efficiency in dosage adjustment. [1][2][3] Whiting et al 4 proposed that a population pharmacokinetics (PPK) model could be imported to a Bayesian module of Nonlinear Mixed Effects Model (NONMEM) software, which may lead to increased efficiency in dosage adjustment.…”

Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics of Valproic Acid in Adult Chinese Epileptic Patients and its Application in an Individualized Dosage Regimen

Jiao

Wang

et al. 2015

Therapeutic Drug Monitoring

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“…These are summarized in Table 3. 12,29,59,62 Ultimately, patients receiving VPA demonstrate widely variable pharmacokinetic parameters due to differences in protein binding and saturation, effects on clearance, and possible diurnal variations. Attempts to define a dose-concentration relationship have found poor albeit statistically significant correlations, and are realistically unlikely to be successful given valproate's fluctuating protein binding characteristics.…”

Section: Vpa Dose-concentration Relationshipmentioning

confidence: 99%

Does Valproic Acid Warrant Therapeutic Drug Monitoring in Bipolar Affective Disorder?

Haymond¹,

Ensom²

2010

Therapeutic Drug Monitoring

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To review the pharmacokinetic literature regarding valproic acid (VPA) in patients with bipolar affective disorder to evaluate the appropriateness of routine therapeutic drug monitoring (TDM) of VPA in this population. Embase, Medline, Biosis, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Systematic Reviews databases (to July 2009) were searched (terms: valproate, valproic acid, valproate semisodium, divalproex, bipolar disorder, mania, bipolar affective disorder, assay, concentration, drug level, serum level, plasma level, therapeutic drug monitoring, drug monitoring, pharmacokinetics). A 9-step decision-making algorithm was applied to the available VPA literature in the bipolar population. VPA has been established as effective first-line therapy in the treatment of bipolar mania. Commercial assays are available to accurately measure VPA levels with good sensitivity and precision. Wide interpatient variability in VPA pharmacokinetic parameters and long anticipated treatment durations favor the use of TDM in the bipolar patient. Conversely, correlations between VPA levels and pharmacologic response in humans, and specifically patients with bipolar affective disorder are unclear. Compared with other agents known to have narrow therapeutic ranges, VPA does not seem to share this characteristic. Furthermore, the clinical efficacy and toxicity of VPA may be assessed in ways other than TDM, allowing for contributions by health care professionals, patients, and family members. Despite the development of effective and widely available VPA assays, routine monitoring of VPA concentrations in the general bipolar affective population does not seem warranted. However, TDM may enhance usual clinical monitoring in situations involving unusual VPA metabolism, polytherapy with clinically relevant drug interactions, or as part of a comprehensive assessment of treatment compliance.

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Spotlight on the Continual Applicability of Routine Plasma Monitoring Antiepileptic Drugs in the Treatment of Epilepsy

Cited by 10 publications

References 0 publications

The effect of combination therapy on the plasma concentrations of traditional antiepileptics

The effect of combination therapy on the plasma concentrations of traditional antiepileptics

Population Pharmacokinetics of Valproic Acid in Adult Chinese Epileptic Patients and its Application in an Individualized Dosage Regimen

Does Valproic Acid Warrant Therapeutic Drug Monitoring in Bipolar Affective Disorder?

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